| | Looking forward and back at health care: An Internet survey☆☆☆★
“Who among us cannot stand in awe at the accomplishments of the last century? The world as it exists today is a monument to mankind’s ability to think, create, and build.”1
As we stand on the threshold of a new millennium, we have a unique opportunity to look back at the marvelous accomplishments in health care during the past 1000 years and to anticipate how health care may begin to evolve during the next millennium. The Journal thought it would be of interest to canvas emergency/trauma health care providers with the following question:
In your opinion, what have been the most important developments in health care during the 20th century and why? How do you think health care will differ 100 years from now?
The questions were posed to the members of the following emergency/trauma Internet lists: WEB-NSG-L, traumanurse.org, EMED-L, and Trauma-L. The responses were varied, interesting, thought provoking, and humorous (see Appendix for list of contributors who provided comments).
Most important developments of the 20th century  The most important developments of the 20th century, listed in alphabetical order, are as follows. The number in parentheses is the number of times the subject was mentioned by a contributor. No number indicates the topic was mentioned by a single contributor.
•Anesthesia advances
•Antimicrobials/antibiotics (20) —Eradication of bubonic plague, cholera, yellow fever; culture and sensitivity testing
A. Rundio observes: “Where people used to die from simple infectious diseases in the past, they are now treated by p.o. antibiotics on an outpatient basis.” P. Boscoe worriedly states: “During this century, antibiotics have significantly decreased morbidity and mortality from many illnesses once considered life threatening. As a result, the quality of life for many individuals has improved dramatically. They (antibiotics) have spawned a powerful multibillion dollar industry that has become a major segment of today’s economy. They have affected the way every physician practices medicine and the patient’s expectations. Unfortunately, their overuse has created more aggressive and resistant organisms that threaten to change the face of the field of infectious disease in the next century, a truly frightening prospect. Their implementation in this century may very well lead to untreatable ‘superbugs’ in the next.”
•Blood banking and blood groups (2)
•Burn care (major)
•Cancer therapies (3) —chemotherapy, radiation therapy
•Cardiopulmonary care (12) —Ablations, angioplasty, cardiac monitors and monitoring equipment, cardiopulmonary bypass machine, defibrillators, hospital critical care units
•Cellular/molecular biology (3) —Applications to medicine, DNA testing, genetic engineering
•Computer technology (13) —Communication, computerization of surgical procedures, consultation capabilities, database management, information processing, medical history availability.
All of us can probably identify with the following observation by C. Cowles: “I can remember going down to the medical center library and looking up in catalogs for hours just to copy some article. Now I can do the same work from my desk in just an hour or so.” He then adds, “I can bring multimedia into a classroom and show a student almost anything that an intricate anatomy lab could (except the smell).”
•Dialysis
•HIV treatment (9)
•Hospitals —Modern ones as opposed to the proprietary hospitals of the past century. In response to this posting, E. Frykberg responded, “This prompts me to recall an interesting statistic I once read in JAMA —though I have long forgotten the exact reference—that in the United States, it was not until 1925 that hospitalized patients had a better chance of survival compared with patients being treated outside of hospitals.”
•Infection control —Knowledge of how micro-organisms spread, how to protect health care workers and patients/visitors
•Injury prevention
•Medical education —Flexner Report of 1910 regarding the poor state of medical education
•Medical ethics —Development as a distinct discipline
•Pharmaceuticals (5) —Antihypertensives, antipsychotics, and the whole field of psychopharmacology, cardiac drugs (β-blockers, thrombolytics), intravenous therapy
•Prosthetics
•Public health (13) —As a viable medical field, sanitation systems
•Radiology (2) —Imaging, sonography, ultrasound, radiographs
•Specialty care –Regionalization of surgical advances (12)—Arterial surgery, laparoscopy, and laparoscopic surgery
•Tissue and organ transplantation (10)
•Transfusion medicine
•Trauma care (4) —Helicopter and fixed-wing transfers, mechanism of hypovolemic shock, principles of wound management
In response to helicopters being identified as a major contribution, E. Frykberg responded, “While helicopter transport clearly improved survival in Korea and Vietnam, there is as yet no clear data to support any benefit in the civilian sector, although most of us would believe it does save lives but only in rural areas involving long transport distances.”
•Vaccines (15) —Control of chicken pox and measles, eradication of diphtheria and smallpox, development of Salk and Sabin polio vaccines
•Women/children (2) —Birth control pill, hospital childbirth with increased Cesarean sections leading to a decrease in maternal morbidity/mortality, in vitro fertilization, mammography, Papanicolaou smear, Rhogam to prevent Rh isoimmunization
Predictions for the 21st century Anticipated changes in health care include the following:
•Alternatives to donor organs for transplants (either mechanical or cloned)
•Body scanning, portable (like on Star Trek )
•Earlier identification of disease
•Gene therapy (2) —Including manipulation of DNA to control disease
•Information management and coordination (2) —Further advancements
•Manipulation of cytokines to replace immune suppression for transplantation
•Medical practice by a family physician or general practitioner (return to high touch from high tech with less emphasis on technology) Along this same line, contributor K. Norman explained her version of the first 2 phases of this cycle:
“Early in this century, your health care provider was likely to be from your own town and share very similar values with you. The same doctor probably delivered you and pronounced your grandparents dead. Today, you were delivered by an ob-gyn, vaccinated by your pediatrician. An internist or gerontologist cares for your grandparents (who are probably still alive and active). All of your various doctors probably went to school in another state or even country, and may not have a similar set of values.” Only the future will reveal whether care will indeed evolve in this predicted manner during the next century, completing the cycle.
•Medical practice by Internet
•Ocular identification
•Point of service everything
•Telemedicine for education and patient management
•Threat of biological warfare, increased
•Virtual reality, use of
A. Rundio projects: “Genetics and genetic re-engineering will be in the next century what antibiotics have been in this century. Medications will be tailored to manipulate genes in order to cure diseases such as cancer, etc.” K. Robinson predicts: “I think hospitals as we currently know them will cease to exist. (They are awfully bureaucratic anyway.) I think that health care will be entirely mobile. Even the sickest people will be cared for in their homes. People will be much more responsible for their own well being. Government and insurance companies will not continue to support persons who engage in risky behaviors, and they will be left to fend for themselves. Family members will play a more integral role than ever to help people stay well and survive.” Conclusion Several contributors added a bit of levity. One stated the most important contribution of the 20th century has most surely been “jelly doughnuts and the 5-gallon coffee urn,” ever present in the ED lounge. A frustrated physician’s prediction for the 21st century includes: “Abolishment of medical schools and practice of medicine by HMO clerks. Using more and more exotic ‘neat’ tests, imaging, and laboratory tests in place of looking or talking to the patient (of course this is already well established), or even needing any special education to practice medicine beyond learning numbers and the alphabet.” He then added: “My projections for the future are of course tongue-in-cheek—just born of frustration.” In response to all the dire Y2K predictions, one contributor informs us: “All that will happen (on December 31) is that those of us working or “on call” that evening are going to go home very tired, and those of us not working or “on call” are going to wake up with very bad headaches. At that point we can all ask ourselves: ‘Is that all there is to a millennium? Is that all there is? If that’s all there is, my friend, then let’s keep dancing.’” Happy 21st century! Happy new millennium!
Appendix Contributors: K. Anderson, P. Bosco, C. Cowles, L. Doddy, B. Freeman, E. Frykberg, D. Geehan, C. Hauser, S. Heitschel, J. Hollinger, D. Horecky, D. LaBuda, G. Lenehan, B. Marett, K. Mattox, N. McSwain, J. Mercado, N. Miller, K. Norman, D. Perrin-Davis, F. Ring, K. Robinson, A. Roy-Shapira, A. Rundio, J. Sexton, S. Sheehy, C. Simon, D. Smith, B. Sterling, T. Trimble, G. Waldby, D. Wasilko, M. Weintraub, S. Wright. Author’s note Sincere thanks to all who contributed information, thoughts, concerns, assistance, and support to this effort. If you contributed and your name was inadvertently omitted, my sincere apologies. References 1.
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Kapp J.
Involved, educated citizens will save us. Voices of our time.
San Jose Mercury News. 1999 Sept 9;Sect. A:4. Iris Frank, Loma Prieta Chapter, is an Associate Editor of the Journal of Emergency Nursing. Santa Cruz, Calif ☆ For reprints, write: Iris Frank, RN, MSN, CEN, 5023 Thurber Lane, Santa Cruz, CA 95065. ☆☆ J Emerg Nurs 1999;25:23A-25A. ★ 0099-1767/99 $8.00 + 0 18/65/102860 PII: S0099-1767(99)70037-1 © 1999 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved. | |
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